Saturday, October 5, 2024

The Beginning of the End of the Adderall Shortage

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It had been months of trying. First, to ration my supply of Adderall before giving up and exhausting my supply; then, I attempted 40 milligrams of Vyvanse as a replacement; the next attempt was 60 milligrams of Vyvanse; then 70 milligrams of Vyvanse, the highest dose one can take. Finally, I was asking my psychiatrist if I could just try some Dexedrine, which led to her calling my former psychiatrist. This brought the realization that most pharmacies were out of Dexedrine, too. So I went the organic route and tried multiple cups of coffee, matcha, and those five-hour energy drinks.

I never believed that I actually had ADD before the Adderall shortage, even though I was diagnosed with the disorder a little over 10 years ago. In 2011, the diagnosis wasn’t presented as a big deal, so I believed, cavalierly, that I had been given Adderall to help me make my deadlines and organize my life. I thought I could work smart, not hard, and hopefully hit the after-work cocktail party circuit with extra vivaciousness. The use of prescription stimulants to treat ADHD has doubled from 2006 to 2016, according to the journal PLOS One, and I was very much part of a growing trend around stimulant use.

I’m ashamed to say it was years before I began using amphetamine salts—the generic name for Adderall—for their intended purpose. I first popped the pills more or less as a party drug. Adderall allowed me to drink longer and stay up later while eating less, which meant I became thinner while socializing more. I remember meeting a girlfriend for drinks one afternoon and watching as she casually dropped a 25-milligram pill into my glass of champagne. Plop. Fizz. Research published in 2016 by the Johns Hopkins Bloomberg School of Health discovered that Adderall abuse was highest amongst 18-to-25-year-olds—just a few years younger than my age when I went down the Adderall rabbit hole.

The following year, while having dinner with an older author who wrote his novels the old-fashioned way—word by word, powered by coffee—I slipped a pill into my mouth before taking a sip of wine.

“What’s that?” he asked suspiciously.

“Oh, you know,” I said. “Adderall. Have you tried?”

“What is it, like coke?” he asked.

His comparison was an insult to the medication. The effects of Adderall and cocaine are very different. Lasting four to six hours or so, amphetamine salts narrow your brain’s focus. Whatever you’re working on—writing an article, reading a book, sloughing through reams of mind-numbing research, or assembling an IKEA bookshelf— becomes the subject of your complete and total concentration. Until the drug gradually—or often, abruptly—wears off, bringing on feelings of depression, despair, and the realization that you hadn’t eaten in eight hours. This can be prevented with weaning, by breaking up the pill into small doses and taking them over time—or taking a Klonopin for a soft landing.

As I got older, I straightened up in my career and drug use. Now working for myself as a freelancer, I take Adderall as my doctor prescribed it to me. The drug has been great for keeping me on task, concentrating, and juggling projects.

All of this worked until it didn’t. In August, trouble appeared on the horizon when Teva, the nation’s largest manufacturer of both branded and generic Adderall, was reported by Bloomberg to be stricken with supply chain problems amid skyrocketing demands. And who was demanding all these pills? Well, everyone, it turned out. As LAMag reported in March 2020, America was already chewing up 83.1 percent of the global supply of Adderall like a Hungry Hungry Hippo. But as the pandemic eased up and we emerged into a world where workers were quitting their jobs in droves and global supply routes went haywire, prescription drug markets were hit particularly hard. A report from Trilliant Health found that nationwide prescriptions for Adderall among people ages 22 to 44 increased by 15% between 2020 and 2021. 

So, when the medication ran out, the bottom dropped from under my focused and productive life. By the time the FDA had officially announced the shortage of immediate-release Adderall in October, my pharmacy had already stopped filling my prescribed Adderall for two months. And I had run out of pills long ago. Teva, said the FDA, was “experiencing ongoing intermittent manufacturing delays.” Walgreens “did not have one single pill,” I was told.

Without Adderall, I felt sedated—constantly, like I was walking through life in slow motion. My ability to concentrate was so far gone that something that would usually take me three hours to write might take me all day. Working from home, I became distracted—looking up Beach Boys lyrics, cleaning, and figuring out how to use double-sided acrylic tape to hang framed pictures. Completing minimal tasks of everyday life—chores, phone calls, making appointments—was out of my reach.

If I was doing so badly without my medication, was it possible I could have ADD for real? I’d never even considered the possibility. 

I called the now-retired psychiatrist who had diagnosed me and asked if he’d prescribed me Adderall because I actually had ADD, or because I worked in a chaotic newsroom at the time. 

“Well, duh!” he said. Dr. D. happened to have ADD himself. “You’re the definition of an ADD chick. And did you know—people with ADD are neurodiverse?” He meant that I had a type of brain that worked differently than a “regular” person’s, basically. I found the reinforcement of his diagnosis a relief. The giant Lego parts inside my head clicked into place. How arrogant to think I’d been cheating at life through chemistry.

For adults to be diagnosed with ADHD attentive type, they must meet at least five criteria. I’m sure my doctor saw them in me from miles away: compulsive, easily distracted, difficulty paying close attention to detail, and difficulty with daily chores, like returning phone calls or paying bills on time. My kitchen table was a stack of ConEd bills stamped “PAST DUE” veering into “SHUTOFF,” which I brought into my appointment one day with my hands thrown upward, given that I had plenty of money to pay them.

That’s the sort of tip-off that would give a good doctor the idea that a patient might have ADHD. In children, however, it is a multi-step process with no single test, according to the CDC. The diagnosis is usually made by a healthcare provider, like a psychologist, psychiatrist, or pediatrician, and also requires the child to meet a number of criteria—with input from the parents about their child’s behavior in different settings.

But the Adderall shortage dragged on for months. On November 17, the FDA announced that the shortage could last 30 to 60 days more. I continued to suffer through my days with the Vyvanse, which made me sleepy, until one day a little over a month ago, I got a phone call.

The voice on the other end of the phone told me to hurry. It was first come, first served, the pharmacist said. If I was late, my bottle ran the risk of being re-shelved and given to someone else. I immediately dropped everything and walked 10 blocks to Walgreens. It was December 28. The pharmacy line was more crowded than usual, and I knew some of these customers were similar to me: neurodiverse, with an attention deficit, or hyperactive. I all but snatched my bag of amphetamine salts when I reached the front of the line. Out on the sidewalk, I shook out an orange 20-milligram pill by Teva and swallowed it. 

The past three or four months taught me that I didn’t need Adderall—not literally, anyway. I could survive without it. But did I want to? Writing—my livelihood—could either be like trying to work while swimming underwater wearing deep-sea diving gear—or it could be exhilarating, with the rush of connecting modern life’s dots while swimming through its slipstream.

By swallowing the orange pill, I’d already made the choice of ease and comfort, of faster and quicker ideas, of enhanced alertness, of being more normal. It isn’t a bad trade-off. The first step was just admitting that I do need it. My name is Sheila, and after 11 years of taking Adderall, I can admit that I’ve been living with ADD all along.

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